Healthcare Provider Details

I. General information

NPI: 1518539972
Provider Name (Legal Business Name): MARIAM ABDULLAHI ISSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAM ABDULLAHI ISSE RN

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 WOLF RUN DR
COLUMBUS OH
43230-4529
US

IV. Provider business mailing address

5515 WOLF RUN DR
COLUMBUS OH
43230-4529
US

V. Phone/Fax

Practice location:
  • Phone: 614-477-9965
  • Fax:
Mailing address:
  • Phone: 614-477-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.449710
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: